Drinking Ketones & Elevated Liver Enzymes Due to CrossFit

Podcast Episode #363: Drinking Ketones & Elevated Liver Enzymes Due to CrossFit

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Drinking Ketones & Elevated Liver Enzymes Due to CrossFitTopics

  1. News and updates from Diane & Liz [1:56]
    1. Book edits
    2. 21-Day Sugar Detox Weekly email newsletter
    3. Shoutout to Jennifer Robbins
    4. Liz's tennis match
  2. What I had for dinner last night [8:20]
  3. Exogenous ketone supplements [15:56]
  4. The evolution of diet through the internet [27:57]
  5. CrossFit and elevated liver enzymes [32:27]
  6. Winding down the summer [41:08]

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Drinking Ketones & Elevated Liver Enzymes Due to CrossFit Drinking Ketones & Elevated Liver Enzymes Due to CrossFit Drinking Ketones & Elevated Liver Enzymes Due to CrossFit Drinking Ketones & Elevated Liver Enzymes Due to CrossFit

You’re listening to the Balanced Bites podcast episode 363.

Diane Sanfilippo: Welcome to the Balanced Bites podcast. I’m Diane; a certified nutrition consultant, and the New York Times bestselling author of Practical Paleo and the 21-Day Sugar Detox program and book series. I live in San Francisco with my husband and fur kids.

Liz Wolfe: I’m Liz; a nutritional therapy practitioner, and author of the Wall Street Journal bestseller Eat the Yolks; The Purely Primal Skincare Guide; and the online program Baby Making and Beyond. I live on a lake in the mystical land of the Midwest, outside of Kansas City.

We’re the co-creators of the Balanced Bites Master Class, and we’ve been bringing you this award-winning podcast for almost 7 years. We’re here to share our take on modern healthy living, answer your questions, and chat with leading health and wellness experts. Enjoy this week’s episode, and submit your questions at http://blog.balancedbites.com or watch the Balanced Bites podcast Instagram account for our weekly calls for questions. You can ask us anything in the comments.

Remember our disclaimer: The materials and content within this podcast are intended as general information only, and are not to be considered a substitute for professional medical advice, diagnosis, or treatment. Before we get started, let’s hear from one of our sponsors.

Liz Wolfe: Today’s podcast is sponsored by Vital Choice wild seafood and organics. America’s leading purveyor of premium, sustainable seafood and grass-fed meats, and a certified B corporation. Now’s the time to grill some sparkling wild seafood and mouthwatering grass-fed meats. Their selection includes wild salmon, fish and shellfish, grass-fed beef and bison. Plus premium pastured chicken and pork. Vital Choice offers fabulous foods for work or outdoor adventures. Luscious, fresh tasting canned salmon, sardines, or tuna. Wild salmon or bison jerky, and more. Be sure to save 15% on one regular order with the promo code BBPODCAST or get $15 off your first Vital Box with the promocode BBVITALBOX from now through the end of the year.

1. News and updates from Diane & Liz [1:56]

Liz Wolfe: Ok. Hi Diane!

Diane Sanfilippo: Hi!

Liz Wolfe: What’s happening over there?

Diane Sanfilippo: Uh; {singsong}, work, work, work, work, work. {laughs}

Liz Wolfe: It’s nothing but work, work, work all the time.

Diane Sanfilippo: Just editing. Editing the new book. Getting through that. I feel like my summers are always this, because the books always come out in kind of the late fall, or sometimes early in the year. So yeah, just working on book edits.

And the other big thing going on, just in our camp over here with myself and Team Balanced Bites/Team 21DSD. We have a new 21-Day Sugar Detox weekly email that’s been really fun to put together. Because we have, obviously, tons of people who are going through the program all the time. And then finishing it, and just kind of wanting that ongoing; a little bit of support, but also just connection around healthy food. Sugar-free stuff. Things that are supportive of that lifestyle overall.

And obviously, even talking a little bit about this whole keto thing that everyone is asking about. We have a question about it today, too, of course. But being able to share coupon codes, and articles. Just everything related to getting junky food, and sugar, and refined stuff out of your life. So if you want to stay up to date on that type of content, definitely check it out. Because I think folks may be seeing that the content in my personal weekly newsletters has shifted a little bit.

I still will always talk about food, because I just love food, and I always share recipes and things like that along the way. But I am talking about more topics now. Things that I’ve seen coming up as relevant and interesting to people who have already made nutritional changes and are looking for what’s kind of next, beyond nutrition. And that’s really where a lot of the work that I’m doing is going.

So I think subscribing to that email will keep people up to date on that type of content. So, that’s kind of new. And I think folks are really enjoying that so far. What’s going on over by the lake?

Liz Wolfe: Well, I definitely want to give a shout out to our friend, Jennifer Robbins, from Predominantly Paleo. Her new book, which releases September 4th, but you can preorder it any time before that. And it’s called Affordable Paleo Cooking in Your Instant Pot. She’s the Instant Pot queen.

Diane Sanfilippo: Totally.

Liz Wolfe: I have her first book. And you know; I don’t cook that much. But I do have her first book; the Instant Pot book. I’ve got it bookmarked, and dog eared, and I pull it out all the time. It’s just the Instant Pot is such a life saver.

Diane Sanfilippo: For Colleen.

Liz Wolfe: For Colleen.

Diane Sanfilippo: {laughs}

Liz Wolfe: Indeed. Thank god for Colleen.

Diane Sanfilippo: I know people are always looking for ways to use their Instant Pot more. So a cool thing on the 21DSD topic, there are actually recipes in Jennifer’s new book that are labeled 21DSD that are friendly for the program. Which is awesome. And that’s actually the first book, outside of my own, to ever label recipes 21DSD friendly, which is really cool. So if you guys are doing the sugar detox, you’ve been curious about it. But you're like; I want really easy recipes. That book will help you.

Liz Wolfe: Awesome. My other update is; I don’t know when this will air in relation to; actually it will air after the first two weeks of tennis. But I have my first tennis; I want to say game. First tennis match. Right? Game, set, match. On Tuesday, this coming Tuesday. So that’s August 20-something. It’s in the 20s there. And then I’m a sub for the following week. So wish me luck! I don’t know if this means anything, but I’ ma purple 10-cap team. Which means beginner, beginner, beginner.

Diane Sanfilippo: {laughs} I would like video documentation of this.

Liz Wolfe: It’s all very funny. I can’t believe I haven’t posted anything about tennis. Maybe I feel self-conscious because it’s so country club-y. It’s just so; you know, I think back to that scene from Sex and the City where Charlotte and Trey are at Trey’s, whatever you call it. His country house.

Diane Sanfilippo: Bunny?

Liz Wolfe: She’s wearing red; it’s whites only. Oh, come on you old fuddy duddy. It’s just so like that, but I’m having a blast. And I’ve got my first match. And we’re playing doubles. We’ll just see how hilariously, just completely pathetic we all are. But it’s going to be really fun. And everyone I’ve met through tennis is awesome. So it will be a good time.

Diane Sanfilippo: I love how sporty you’ve come back to being.

Liz Wolfe: I know!

Diane Sanfilippo: When we first started this podcast; people have recently asked a lot how we met. I’m like; we met because of the podcast. We didn’t know each other before this. But we both used to do CrossFit. And actually when we first were traveling to teach seminars, we dabbled with actually dropping in at some of the gyms either around where we were going to be, or the gym that we would be teaching at. Like maybe the day before we did a workout. I remember we were lifting for sure in Texas at one point.

Liz Wolfe: Mm-hmm. I was CrossFit certified for however many years they let you; 5 years? I don’t know.

Diane Sanfilippo: Probably like 5 minutes.

Liz Wolfe: Hashtag; did not renew. {laughs}

Diane Sanfilippo: {laughs} That’s another interesting new development in our camp over here. Scott is actually getting his level 1 cert, and going to be coaching some CrossFit classes.

Liz Wolfe: You know; it’s good information. It really is. And Scott is highly qualified.

Diane Sanfilippo: Totally.

Liz Wolfe: He understands how to body moves. I was 100% enthusiast who was like; yeah, that’d be cool. Let’s do that.

Diane Sanfilippo: Totally. But yeah, we were totally doing CrossFit. 100%. When we first did this podcast. But it’s been 7 years, actually. So interesting.

Liz Wolfe: Well, and you and I were both athletes, right? As kids? I played field hockey, basketball, soccer.

Diane Sanfilippo: And 7 years younger?

Liz Wolfe: I know. But it feels natural. But I will say just with how; ugh, how the grind of adult life never stops. If I didn’t live at a place that was just such an active community, and if I couldn’t step right outside my door and walk a four-mile loop around the lake. Which I did this morning. I would not be this active. I wouldn’t.

But I’ve figured it out. I’ve figured out the formula that’s working for me to actually get my butt in gear. And that’s good.

Diane Sanfilippo: I love it.

2. What I had for dinner last night [8:20]

Liz Wolfe: OK. Last night’s dinner is the name of this segment. What was your dinner last night?

Diane Sanfilippo: Luckily, I can refer to Instagram. So while you remember what you ate for dinner last night.

Liz Wolfe: {laughing} Will you also explain shishito peppers to me? Because I’m seeing them everywhere.

Diane Sanfilippo: Yeah, I will.

Liz Wolfe: I know that was a meal from like a week ago for you.

Diane Sanfilippo: Ok. So dinner last night for me was arugula, no surprise there. And on top of that, I reheated some leftover Souvla chicken. For those of you who know about the salad that I get all the time from Souvla here in San Francisco. Which, many of you have reported visiting San Francisco and going to get this salad. And I feel very proud, and I’m very glad that you had this really yummy meal.

But we always order extra chicken. So if you live in San Francisco, and you're ordering, always get the extra so you have it for the next day. So I reheated that extra chicken. Used some of the extra yogurt sauce that we also order. Lemon, olive oil, heirloom tomatoes in season right now.

And then I put some Go Raw brand; this is not sponsored. I just found them at Costco, and I actually really like that brand. They have a lot of products that I really like. They do a sprouted pumpkin seed. And they have a lot of different sprouted seeds. I think I bought sprouted sunflower seeds from them, as well, at Costco recently.

But you guys know, several episodes back, Dr. Jolene Brighton was on talking about seed cycling. Which I don’t know that I talked about it on the podcast before. But I have been aware of seed cycling for many, many years. I honestly did not know that it was as simple as it is. So when I first heard about seed cycling, many years ago, I was like; oh that sounds complicated. But it’s actually just two different types of seeds to eat the first two weeks of your cycle, and two different seeds to eat in the second two weeks of your cycle. So if you're curious about that, check out the episodes that we did recently with Dr. Jolene Brighton. She talked about it.

Anyway, long story short. I’ve been trying to throw sprouted pumpkin seeds onto my salads; or whichever relevant seeds are in the mix. I’m easing my way into seed cycling. I’m not taking it too seriously yet. I’m just trying to get myself used to using those seeds.

Anyway, so that was it. And it’s on Instagram. But that will be kind of a ways back in the feed by the time this episode airs. So that was dinner last night. Nothing too shocking. What was your dinner last night?

Liz Wolfe: I actually cooked last night. And I said to my husband, when I was in the middle of cleaning up the mess from cooking. I was like; you know, sometimes I really feel like cooking. And it takes me about 30 minutes to remember why I’m not a huge fan. Because the clean up is just always; blah! And I don’t want to eat until everything is cleaned up.

Diane Sanfilippo: Oh, that’s interesting. I don’t have that problem.

Liz Wolfe: {laughs} Because I don’t like; I like the last thing that I do…

Diane Sanfilippo: To be enjoying the meal.

Liz Wolfe: To be enjoying the meal! And the rest of the evening is relaxing to the degree that I can. But, eh. I know. The worlds most tragic sound on the smallest violin.

Diane Sanfilippo: Some people are really good at cleaning up while they cook. I am not that person.

Liz Wolfe: I’m not either.

Diane Sanfilippo: Luckily, Scott is more irritated by the mess faster than I am. {laughs} So he tends to swoop in and clean the mess. But at least I’ve made something really yummy. So what did you cook last night?

Liz Wolfe: Helpful. So, I made kind of enchiladas. You know; kind of my go-to is like, enchilada casserole. But we have a relatively clean enchilada sauce that we have access to out here. And then I use that, and some sprouted corn tortillas, and shredded chicken, and a little bit of pepper jack cheese, and a ton of guacamole we also made last night. Because my daughter likes to mash the avocado. It’s a relatively innocuous task we can give her {laughs} while we’re cooking.

Diane Sanfilippo: I love that.

Liz Wolfe: Yeah, so we ate quite a bit, and had some Siete Foods sea salt chips, as well.

Diane Sanfilippo: I love that. Was your shredded chicken something that was precooked, or did you have chicken around?

Liz Wolfe: No; I cooked it!

Diane Sanfilippo: You made the chicken first and then put it into the enchiladas?

Liz Wolfe: Yes. Is that wrong?

Diane Sanfilippo: No. I mean…

Liz Wolfe: {laughs}

Diane Sanfilippo: Endeavoring to really multiple steps there. {laughs}

Liz Wolfe: I know. I know. We bought some Campo Lindo Farms chicken breast. Which I’ve been getting at Whole Foods. Because I know I’m kind of cheating. I just want some pasture raised chicken breast. I don’t want to deal with the whole chicken right now. Because the carcass is just going to go to waste, and it’s just going to be really sad. So. They’ve been carrying those at Whole Foods. Which they usually don’t. Usually, you can only get, at most, the split chicken breast that you still have to debone and all that stuff.

But they’ve been selling; at least to me, they’ve been selling the boneless, skinless ones.

Diane Sanfilippo: {laughs} You're like; I’m the only one buying all these pastured chicken breasts.

Liz Wolfe: Just me. I’ll take it! They might just be holding it for me. But you know, I don’t buy chicken from Whole Foods most of the time. Because at best, their animal welfare rating is like; not in cages, all the time. You know. It’s just not enough. And this, I think the animal welfare rating is either a 4 or a 5. And it’s local. So I like that.

So I’ve been buying that. And using my; of course I’m going to forget what it’s called now. Jaccard meat tenderizer. Which is awesome. It’s this little thing that you mush down, and it makes these little microscopic cuts inside your meat. Whatever you need tenderized. And it makes pastured chicken really, really good and tender.

Diane Sanfilippo: That sounds good.

Liz Wolfe: Yeah.

Diane Sanfilippo: For those curious about the Instant Pot; cooking chicken breasts in the Instant Pot is so easy.

Liz Wolfe: Yeah.

Diane Sanfilippo: Actually, friend Beth from Tasty Yummies has done this little hack. Where after you take a whole bunch of chicken breast, and cook it in the Instant Pot. Or chicken thigh, whatever you want. When you take it out, you can throw it into; if you have a Kitchenaid mixer, which I do not. I think those are for people who bake, but maybe I’m wrong.

Liz Wolfe: {laughs}

Diane Sanfilippo: Do you have a Kitchenaid mixer?

Liz Wolfe: Is that the standing thing with the bowl?

Diane Sanfilippo: Yeah, like a stand mixer.

Liz Wolfe: No, but I wish. Sometimes I want to make cookie dough and eat the whole bowl of cookie dough.

Diane Sanfilippo: Ok. So, like you could also use the handheld kind. Which I have. And until recently, I had one from the 1970s that I think I took from my mom. {laughs} I don’t even know if the little paddles fit. Anyway. You basically just use a mixer for a few seconds, and it shreds your chicken. And you don’t have to stand there with two forks.

Liz Wolfe: Smart.

Diane Sanfilippo: Yeah. It’s a life hack. So I love that. But I don’t have a stand mixer. I could probably whip out those little. I just ask Scott to do it, because he’s really quick at those things. So anyway.

Liz Wolfe: The Balanced Bites podcast is sponsored in part by the Nutritional Therapy Association. The NTA trains and certifies nutritional therapy practitioners and consultants (including me; Liz, I’m an NTP), emphasizing bio-individuality and the range of dietary strategies that support wellness. The NTA emphasizes local, whole, properly prepared nutrient dense foods as the key to restoring balance and enhancing the body’s ability to heal.

The NTA’s nutritional therapy practitioner program and fully online nutritional therapy consultant program empower graduates with the education and skills needed to launch a successful, fulfilling career in holistic nutrition. If you're interested in learning about holistic nutrition but don’t necessarily want to become a practitioner, check out their new Foundational Wellness course. To learn more about the NTA’s nutritional therapy programs, resources, and to enroll in their free course, Nutritional Therapy 101, visit http://www.NutritionalTherapy.com.

3. Exogenous ketone supplements [15:56]

Liz Wolfe: OK. So we’ve got two questions today. The first one should be a fun one. This is about drinking ketones. The question is, “One of my friends has been drinking ketones. They are bioidentical to those that our body makes. She has seen great results physically and mentally. She has more energy and still eats an appropriate amount of food. I’m curious to hear your take on this. I’m curious about the short and long-term effects on our bodies with this. I get the keto diet; I do think it’s effective. I also know it’s not sustainable for most people. Can drinking ketones be ok for a short while? But then won’t one just gain the weight back? Can you take this while nursing? So many thoughts are popping into my mind about this. Thank you.”

Any thoughts?

Diane Sanfilippo: Yeah. So this is definitely a really popular question, people are very, very curious about the topic of exogenous ketones. So a couple of things here; first and foremost. When we’re talking about a keto diet and why and how it’s effective, the presence of ketones is an interesting element. So the presence of ketones and being on a keto diet in order to force your body to move away from burning glucose primarily for fuel, and burning ketones instead. It’s not the only way to lose body fat. And I’m definitely talking about this a lot in the new book, because I think it’s just this crazy misconception, or misperception about the benefits of a keto diet.

I’m just going to lay this foundation before I talk about specifically drinking exogenous ketones. So what happens when we remove most of the glucose from our diet, and really keep that amount very, very low, relying primarily on vegetables and maybe very small amounts of other carbohydrates is that we don’t have enough glucose. Our body needs to do something else in order to get fuel. It starts to create ketone bodies through various physiological processes. Breaking down fat as a fuel source.

This is not the only way that we burn fat. Obviously, we know that there are people who eat plenty of glucose in their diet, and do burn body fat. I mean, obviously there are people who lose body fat who aren’t eating for ketosis.

That being said; the presence of ketones in the blood stream is typically an indicator of a very low amount of glucose. And our body is switching its primary metabolic fuel source. That being said about the presence of ketones; what happens when we take them exogenously? Meaning; endogenous would be made within the body. Exogenous means outside the body and we’re taking it in. We’re basically pushing or forcing this higher level of ketones in our blood stream.

Now, where I see the potential short term benefit of this, for some people, is when you're first shifting from a higher carb to a keto type of diet, and you're experiencing carb flu. Which is that really uncomfortable; my body is in between. It’s not used to yet burning fat for fuel. It’s still kind of looking for more glucose. You're getting headaches. You're feeling tired. It’s just uncomfortable. And this has happened to people. We’ve talked about accidentally going low carb countless times on the show. And this happens to people even just going paleo, for example. Or just dropping grains from their diet. They go through this period of time where it’s just really uncomfortable. It happens on the sugar detox, as well.

Taking in some of these exogenous ketones, while your body has not yet adapted to making more of them can make that transition more comfortable. Does it make you more effective at burning fat for fuel? I think it’s a misconception. You still need to be paying attention to how much you're eating. Because you can’t simply take ketones and say; great. Now my body is just going to tap into body fat to burn for fuel if I'm still giving it same amount of calories that I have been this whole time. And I don’t need to tap into what’s stored.

So, I think there’s this misconception that we’re magically burning more body fat by taking these ketones. That being said; because something like MCT oil, we know does not get processed the same way as other fats. It’s medium chain triglyceride. It’s not the same as using coconut oil. Those actually directly fuel the brain. So, this is something that ketones also do. I think they can make you feel better, for sure. You might clear some brain fog. You're directly fueling your brain with something that it really, really likes. So I think that can feel really good.

But I don’t know that I would approach it the way I think a lot of folks approach it. I think some people who have neurological conditions might benefit from them longer term. I think it can really help in that transition period. But in terms of; this is like any supplement we talk about, right. In terms of assuming this is the magic pill; the magic bullet, the magic secret to accelerated fat loss. I would not say so. Not that this is the ultimate of the question that she’s asking.

So for a short period of time; yes. I think some people end up trying to eat higher carb meals sometimes, and then take these exogenous ketones, hoping it will push them back into ketosis. Which; ok. If you're somebody who needs and wants the neurological benefits of being in ketosis, then there could be some great benefits to that.

That would be really dangerous for a type 1 diabetic who is eating keto, and then thinks they’re going to throw a bunch of carbs in the mix, and then take exogenous ketones to “fix it.” That’s not going to happen. Someone who is type 1 diabetic and decides to go keto really needs to stay there, and not dabble with increasing carbs.

This is one period of time when people do try to add these exogenous ketones. They’re like; I wanted to eat a bunch of carbs, so if I just have some ketones with it, then it helps me to get back into ketosis. I’m like; that’s fine. And it’s a physiological response. But is that what you were actually trying to do? Because I’m willing to be that 80-90% of people who are dabbling with keto really are looking for fat loss. And you're not going to burn more fat, just because your body is back into ketosis. Especially not if you are also experiencing high levels of glucose, and high levels of insulin.

And in fact; I’m not a research biochemist. I’m not a scientist. I’m not a medical doctor. But, I’m a thinking person. And what occurs to me is that if you're eating a bunch of carbohydrate, your body wants to have glucose rise. Have insulin and other signaling effects to bring glucose down. And have that normal response. It’s not normal to have a high level of ketones in your blood stream at the same time as glucose.

Our body will normalize blood glucose to not have us go hypoglycemic. All of that is very, very tightly regulated. Unless you're diabetic or clinically hypoglycemic. So your blood sugar is going to be very tightly regulated, but imagine this. You're eating a bunch of carbohydrate. You're not supposed to have a high level of ketones in your blood stream, if you're eating a high level of carbohydrate. So I think you're messing with your natural physiology if you're taking that approach. So it’s not something that I recommend.

And I’ll talk about this in the new book. The new book really is kind of a beginner’s approach to keto. So I’m going to touch on it as a frequently asked question, but I’m not going to dive into a million scenarios of when and why and how to dabble with exogenous ketones. Because frankly, I think that most people who are new to this don’t need to be touching that. I think that they can be helpful for the biohacker crowd who just want to play with it. And I think they can be helpful for people who are struggling with neurological diseases. Whether it’s Parkinson’s, Alzheimer’s, epilepsy. Any other type of neurological condition where somebody wants that support.

So, long story short I think that; look. If somebody feels great using them. Go ahead. I think it’s always important to take a time away from them and just reassess how you're feeling. I would not feel into the trap of, you need this to go keto. I’ll remind you guys; almost 10 years ago when I first went keto, I didn’t know anything about exogenous ketones. Nobody was talking about that. Nobody was talking about keto. I didn’t know anything about taking electrolytes. I did not feel any ill effects of not taking electrolytes at the time. I was eating plenty of bacon, so I was getting lots of sodium. I was eating plenty of mineral rich veggies, and soups and broths and things like that. So I was getting them in my diet.

But all of that to say; they can have a time and place. I just don’t think it’s important for people to feel like you need that stuff. And, you know, that’s how supplements are. People really start to rely on them, or feel like that’s what’s making the difference. When in reality, it’s just the metabolic processes that your body is going through.

So, she asks, “Can it be ok for a short while?” Yes. “Then won’t you just gain the weight back?” You're not losing weight just because you're taking the ketones. Just having ketones present doesn’t magically make you burn more fat, if you're consuming a lot of fat as well. Your body still needs to be in a deficit of energy that you're taking in in the form of calories in order to tap into stored body fat. The benefit of being in ketosis is that you're primed to look for body fat when you feel hungry. When your body is between meals. When you're fasting.

Whereas; and this is the big thing I want for people to know. When you're eating a higher carb diet, and you get hungry after 2 or 3 hours, your body is more primed to be looking for glucose. So it’s harder to tap into stored body fat for fuel. And that’s why for a lot of us, not everyone, eating lower carb feels more comfortable. Because we’re not getting hungry as often. We can give our body more time to naturally tap into stored body fat. Because when you're hungry is a time when if you're primed to burn fat, that’s when you start burning fat.

Liz, you and I used to talk about this in our seminars we would teach. We’re not trying to tell anybody to be starving. But that hour or so when you first feel hunger, to when you actually eat a meal. If you're in a place where you're not eating high-carb, and you can kind of chill out and be like; ok, I’m hungry. Now I’m going to cook dinner. And that hour goes by, or whatever, and now I’m having dinner. In that hour between when you got hungry and when you ate, your body was burning fat for fuel.

Unless you were eating super high-carb, and you guys know, you can’t go that hour. You start to really tank out and get to that hangry place. So this is the difference. And it’s not just this magic shotgun to lose weight.

Can you take it while nursing? I can’t really address that question, unfortunately. I don’t know what the up or down sides would be. And I think you should really talk to a well-educated physician about that. But those are kind of my pros and cons. I think it can be helpful in the short term. But it’s definitely not a magic bullet. And it’s definitely not the key to fat loss on keto. That’s not going to be what makes or breaks you, is whether or not you take exogenous ketones.

Can you tell I’m writing a book about this? {laughs}

Liz Wolfe: It almost seems like you know what you're talking about.

Diane Sanfilippo: I’m very steeped in this little world right now.

4. The evolution of diet through the internet [27:57]

Liz Wolfe: Well, it’s a big world. And it’s kind of crazy how; I mean, you and I were kind of age when the first Atkins craze. The very first; the first time any of us heard the word keto or ketogenesis. Probably in the 2000s. Maybe in there somewhere. It’s just so interesting to me how; I guess it also has to do with the internet and how we communicated, as well. But just how big it was then compared to how gigantic it is now. It’s very, very interesting. Just the whole concept.

And how much more developed it is now, obviously.

Diane Sanfilippo: Yeah. I think there’s a couple of things happening. I do think the paleo movement has fed into this. No pun intended. A little bit, because I think what we did with paleo, and everything surrounding it was demystify the concepts of eating fat being unhealthy. Like, we really got people to come back around to identifying fat as a healthy way to fuel yourself. So we’ve gotten around that dogma and that mentality.

So then, now people aren’t as scared of fat. And they’re also seeing a lot of people get amazing results. And to your point about the internet, a lot of people got amazing results on the Atkins diet. There just wasn’t this virality of, I share a post of my before and after, and potentially hundreds of thousands of people can see it within minutes. And that is something that; it’s a beautiful thing about the internet. That people can share information really, really quickly. And it doesn’t need to come from a doctor.

Because as we know, social proof is a much more powerful tool than any scientific study. And the reality is, there are not research studies on a lot of these different ways of eating that we can follow. Because it’s very, very difficult to conduct those studies. It’s very difficult to conduct them if you're not sure what the outcome might be. If it could potentially be dangerous for someone, then you can’t run those studies, because that’s immoral.

So, there’s a lot going on. And we’ll talk more about this, as we obviously head into the end of the year and people are asking about it a lot more. But yeah, I have a lot of thoughts about it. So we’ll see how this develops.

Liz Wolfe: You know what I liked about the Atkins diet, back when I did it in college, actually. Was it really was kind of this first time I was ever like; ok, yes I approached it with a mindset of, I want to lose weight. Which I think a lot of people maybe come into this because it works fast, and they’re not really thinking about the overall picture, and all the nuance and what not. And that’s certainly why I took it on. But I also remember it being the first time I realized you didn’t have to be hungry while trying to lose weight. And I thought that was really interesting. And I think it definitely set the stage for some of my interest in diet and health later on, after college. Just thinking about the idea that you can eat to satiety and still feel really good and still feel full. Before that, it had always been starvation and of course, that’s about the worst thing you can do.

Diane Sanfilippo: And that’s the biggest thing that I’m trying to communicate with the new book, too. There are people for whom low-fat can work. I never want people to not eat enough fat to assimilate their fat-soluble vitamins or to get those nutrients. But if you feel good eating more carbs and of course I always like for people to eat real food carbs. But if you feel good eating that way, I’m not going to stop you if it’s working for you. But a lot of us don’t feel good eating that way. Or we feel hungry too often, and it becomes a burden. And it’s just annoying, to get hungry that often.

Practically speaking it’s annoying to get hungry that often. To have to cook again. Logistically speaking, you know. Emotionally speaking. The emotional distraught that people go through every time they need to choose what to eat again that day is really taxing. I think anybody who has dieted knows what it feels like to be under emotional stress every time you feel hunger. I think that happens to people. It’s like; oh, no. I’m hungry again. What do I eat? Am I choosing the right thing?

So I think what moving towards this high fat, low carb keto approach does for a lot of people, it alleviates that decision making. And that emotional component. Because you're just not hungry as often. And it can be really helpful.

5. CrossFit and elevated liver enzymes [32:27]

Liz Wolfe: Yep. Alright. Question two. Elevated liver enzymes in relation to CrossFit? “Your podcast is my favorite. I look forward to it every week. I wanted to reach out for some advice on understanding my recent lab results from my physical. I hadn’t had a primary care doc in three years. My OB/GYN had done my blood work two years ago, and all normal. This week, I got my lab results back and was told all levels were normal/good, including cholesterol, triglycerides, glucose, vitamin D. But that my liver enzymes were elevated. The nurse asked if I had had any alcohol within a day or two of getting the blood work done. I said I hadn’t. She said most likely the cause is fatty liver, and I would need to come in for an ultrasound.

I was looking up causes for fatty liver, and I’m reading it’s associated with obesity and diabetes. I’m 31 and have been doing CrossFit for over 3 years. I’m athletic, and have a lot of muscle. My BMI is higher, I think because of the muscle I’ve put on. I’m 5’5”, and wear a size 6/8. I started reading more possible causes of elevated liver enzymes, and read that could be associated with intense training. And when I think back to the day my blood was drawn, I remember thinking how sore I was after the last couple of tough CrossFit workouts. Could that be the cause?

My doctor wants to do the ultrasound, but should I push for another blood test? Thanks for any advice you may have.”

And here’s an update from later. “I had an ultrasound done, and liver and kidneys looked fine, but the second blood test, about 14 days later, showed my liver enzymes were even more elevated. Doctor is now having me come in for a third blood test to see if it could be hepatitis. But I can’t help but feel it’s from my CrossFit.”

Diane Sanfilippo: Such an interesting question.

Liz Wolfe: I know. Can I give a personal anecdote real quick?

Diane Sanfilippo: Sure.

Liz Wolfe: I recently had some blood work done, and I actually also had elevated liver enzymes. And silly me, the week before I had had dental work done. So I was under a lot of stress, and I also took acetaminophen, because I was in a lot of pain. And acetaminophen is actually proven to elevate liver enzymes. So it could be quite a few things. But that actually ended up being the case for me, which was very interesting.

Diane Sanfilippo: Yes. And in my research, there were a myriad of things that could cause elevated liver enzymes, for sure. Nonsteroidal anti-inflammatories, all kinds of different medications. Actually, almost everything that can cause gut inflammation, will cause elevated liver enzymes. And that seems like in a response to just general gut inflammation as well. So when I was reading through the list; whatever study it was talking about everything that can cause elevated liver enzymes, I was like; this looks vaguely familiar. It looks like a chart that I wrote about digestive health.

So, short answer is absolutely yes, this can be as a result of your increased exercise intensity. I can’t imagine; I don’t know how much time you need to take off of training to see this elevated enzyme level come down. I don’t know if it would be one week, two weeks, three weeks. But this can definitely just be a response from muscle tissue healing.

This is not medical advice, but it’s not pathogenic. Meaning, there’s not a disease state associated with this. This is just kind of; it seems to be a not very well studied response to intense exercise. So when I was looking over other causes of elevated liver enzymes, I know for sure in somebody who is not doing CrossFit or high intensity exercise. Which, Liz, you could have had the higher enzymes just from your training, too. Even if you're not doing CrossFit, that could definitely contribute to it. So keep that in mind if it happens again.

But autoimmune disease is another huge reason for elevated liver enzymes in someone who otherwise is like; I don’t know what’s going on. I don’t drink. Non-alcohol fatty liver disease and also alcoholism, drinking alcohol, all of that can contribute to it. But I remember talking to Robb Wolf about this many years ago, when my dad had to have his gallbladder out. And Robb was talking about; all other things being equal. Not this high intensity exercise. Not somebody who is doing other things that would contribute to it. But this sign of elevated liver enzymes could be a sign that someone is gluten intolerant, has celiac disease, has some kind of autoimmunity going on.

So it’s an interesting thing to note, because you might have a family member who doesn’t get tested for markers of autoimmunity, but comes back with elevated liver enzymes. And I think it’s an interesting topic. Because let’s just say your family member is not doing CrossFit, and is not a drinker. And it’s like; why are these liver enzymes elevated? It’s an interesting note that it could be a sign of autoimmunity. Definitely not diagnosing anybody here.

But all different types of drugs can be a cause for this as well. So if she was doing CrossFit, and she was taking any type of pain killers, over the counter types, that could definitely elevate them further. Get the test; fine. Get tested for hepatitis C. You do want to rule that out. You don’t want to be sitting here like; oh, it’s fine. I’m fine. And then what if there is something going on that you didn’t know about.

But it seems like this is something that there are some studies on it. There are some examples where they’ve had men come in, and they were trying to prime them for different types of liver tests, and they found that these enzymes were elevated. And they kind of sent them home, and said don’t exercise for X amount of time. Come back and everything looks fine.

So it’s interesting. I think it’s good to know that it’s not something that is a disease state, and it’s just a normal response to increased activity. It could be a case for just supporting the liver in terms of looking at the meal plan in Practical Paleo for supporting liver detox. It could be a case for that. Taking some milk thistle, or doing some other things to support liver function, knowing that intense exercise causes some effects in the body that are maybe not always; I don’t know, they don’t seem good on paper, I guess. And I don’t think that it’s anything to be worried about. But if you are trying to get blood tests to be cleaned up; this is something that we talk about with people who are like, oh my cholesterol came back XYZ. And we’re like; ok, in the short term if you're trying to impact that.

So, in the short term, if you want these liver enzymes to come down, it would probably be a good idea to chill out from the CrossFit for a couple of weeks. Somebody might need to take blood tests before getting quoted for life insurance. Or some kind of other health insurance. So if you need to get these numbers to come down, I think it would be worth backing off of that for at least a couple of weeks ahead of when this test is going to happen. Just doing things like yoga and walking, foam rolling and stretching and all of that that is more recovery based, and see where you go from there.

And you know, this could also be a case for just more recovery between the CrossFit, and not try to hammer yourself down. Because even if it’s not caused by a disease state, it might be nice to just kind of moderate that activity a little bit. And I know, typically, a crossfitter is not one to moderate things in general. So, I think it could be just a case for interspersing your CrossFit workouts with things that are a little bit more recovery based.

Diane Sanfilippo: Today’s podcast is sponsored by Kettle and Fire bone broth and soups. We’ve talked about bone broth before and the many benefits, but to name a few, it’s been shown to reduce inflammation, improve digestion, and improve the quality of your skin. While I do like to make my own bone broth, and I especially like making it in an Instant Pot, there’s not always time for that. Kettle and Fire is the next best thing. They use organic chicken bones, and a slow simmer time to extract as much protein as possible. Not to mention that they use chicken feet; (yay!) which increases the collagen and gelatin. And you can store it directly on your shelf for up to two years. Which is pretty cool, considering they’re a fresh, never frozen broth with no added preservatives or additives. Check them out at www.KettleandFire.com/BalancedBites and use coupon code BalancedBites for 10% off, plus free shipping when you get six cartons or more. That’s one per customer. It’s 10% off, and free shipping on six cartons or more.

6. Winding down the summer [41:08]

Liz Wolfe: Alright, so. The final days of summer. What do you have going on these last days of summer, Diane?

Diane Sanfilippo: Well, first of all, we say summer as if summer is a thing in San Francisco. Which it is not.

Liz Wolfe: Right. Ugh, you brat.

Diane Sanfilippo: I’m sitting here in a robe, because I had to turn off my space heater. People joke that August is “Fogust”. So it’s super foggy.

Liz Wolfe: That’s kind of funny! {laughs}

Diane Sanfilippo: Yeah. Super foggy. In the 60s. Outside the city gets very, very warm. Scott was playing golf recently, and he said it was in the 90s. And he really enjoyed driving back into the city, where it was this bubble in the 70s. I was like; yes! Ok. He’s with me now on this cooler weather.

So, honestly, I’m just finishing up book work. And I know you and I are going to be together soon in Nantucket for a few days for a trip. And I’ll be back east for a few days around that. Other than that, that’s kind of it. That’s what’s going on over here. What about you, closing out the summer.

Liz Wolfe: Yeah, I’m just now learning, as a mom of a 3-year-old, that there are 2 weeks in August that are absolutely terrible if you have a child that’s not elementary school age, and you can’t get rid of them during the day. Not really terrible. But basically, all the nannies, all the babysitters, went back to school. And about a week, two weeks ago, my mom, who is a teacher, who was with me all summer, went back to school August 1st. The other gal that was helping us is also a teacher, went back to work August 1st.

Look. I know there were some other options for me. I probably could have hired; it wouldn’t have made a difference to hire a high school kid. But knowing myself as middle-high schooler, babysitting. I probably shouldn’t have been doing that. {laughs} And when I see these millennial nannies; their faces are glued to their phones. And I can’t take it. So I prefer to hire somebody just a little bit older. And that’s just what I’ve noticed. It’s not true of everyone, obviously. But there’s this period of time where all the babysitters are gone, but preschool hasn’t started yet. So, we’re just in that right now. We’re just in it. We need some structure. We need something to do. We need a change of pace. And we just don’t have that, at all. And it’s tough, man. It’s tough.

Diane Sanfilippo: Yeah. Since when does school start in August? Because I’ve noticed that across the country. And I feel like we all did not go to school in August.

Liz Wolfe: Until after Labor Day.

Diane Sanfilippo: Yeah.

Liz Wolfe: Yeah.

Diane Sanfilippo: We finished school sometime around the end of June, and we had July and August off. And then September was when you go back to school. Why is this happening in August now?

Liz Wolfe: Full on, 3-month summer. And to my knowledge, holiday break and spring break have not gotten longer. It’s not like they’re taking a bite out of summer to give us more time during the year. It’s not like that. It’s all very interesting. And also; when we were little, it was half-day kindergarten. But I understand now there are more working parents.

Diane Sanfilippo: Maybe that’s it. They’re like, please take the kids back sooner.

Liz Wolfe: I think that’s part of it. I think it probably really is. I don’t want to say values, because that puts judgement on the situation. But values have changed. I work, and my husband works. I have some flexibility, which is also added stress sometimes. But it’s just different now. I feel like when I was a kid, every single mom was a stay at home mom. So I don’t know.

Diane Sanfilippo: My mom was a teacher, and was home shortly after we were home, just because her day was also over.

Liz Wolfe: Yeah. It’s super interesting. But we’re just kind of white-knuckling it right now, to be very honest.

Diane Sanfilippo: I think that’s fair.

Liz Wolfe: It happens. Alright, that’s it for this week friends. You can find me, Liz, at http://realfoodliz.com/ and you can find Diane at http://dianesanfilippo.com. Join our email lists for free goodies and updates that you don’t find anywhere else on our website or on the podcast. While you’re on the internet, leave us an iTunes review. See you next week.

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